[Fibrates - the present state of art]

Peroxisome proliferator-activated receptor (PPAR)α activators (fibrates) are one of the major group of hypolipidemic agents. Apart from lowering plasma lipid levels, fibrates produce many other favourable effects that may potentially contribute to their clinical effectiveness. Administered to patients with abnormal glucose and lipid homeostasis participating in our studies, these agents reduced monocyte and lymphocyte secretory function, systemic inflammation, hemostasis and normalized adipose tissue function and these effects did not correlate with their lipid-lowering properties. These beneficial pleiotropic effects were observed in patients with mixed dyslipidemia, isolated hypertriglyceridemia, impaired glucose tolerance, metabolic syndrome and type 2 diabetes mellitus and their strength was similar to that of statins. However, large clinical trials assessing fibrate effectiveness in the primary and secondary prevention of cardiovascular diseases provided contrasting results. In our article, we summarise the present state of knowledge on the role of fibrates in the treatment of metabolic disorders, which leads to the conclusion that fibrates are most probably efficient in primary and secondary prevention of cardiovascular diseases, particularly in patients with mixed dyslipidemia and lipid abnormalities coexisting with disorders of carbohydrate metabolism.